The delivery of health care for diseases affecting the nervous system is among the most expensive in the medical arena. During my career, I have witnessed the proliferation of expensive diagnostic tools and costly therapeutic options for diseases as diverse as multiple sclerosis, brain tumors and aneurysms.

Physicians as a group, and specialists in particular, have been early to adopt high-tech medicine,

however rarely consider costs in our personal treatment algorithms.

Unfortunately, many of the expensive treatments we have adopted have not proven effective by Level I scientific evidence (i.e. prospective randomized controlled trials) or rigorous comparative-effectiveness trials.

We can no longer continue to practice medicine in this way.

Since the 1960s, healthcare expenditures have increased by approximately 10 percent annually—more than double the inflation rate. Currently, hospital costs account for 31 percent and physicians 21 percent of total healthcare spending. By 2015, total healthcare expenditures are projected to reach $4 trillion and represent 20 percent of the gross domestic product (GDP). If we continue to practice this way, we are projected to spend 40 percent of our GDP on health care by 2040.

A core reason I thought we should form Santa Barbara Neuroscience Institute at Cottage Health System was to begin the important reformation of local medical care from the ground up. It is time physicians take charge and not wait passively while our federal government imposes more restrictions on our ability to innovate and improvise. To borrow terminology from the book Redefining Health Care by Michael Porter and Elizabeth Teisberg, we are forming “integrated practice units” to manage neurologic diseases over the entire spectrum of care.

Our goal will be to measure outcomes and keep altering what we do to improve outcomes and lower costs along the way. As Porter and Teisberg have written, “unrestricted competition based on results is the best and only real cure for the problems of medical errors, under-treatment or over-treatment.”

By the simplest measurement, value in medicine is determined by the health outcome per dollar of cost. Our aim is to deliver the highest possible value.